On the afternoon of January 18, Susan Kilby and Dorothy Kelly of the Foundation for Senior Living in Phoenix presented an in-depth training workshop on caregiving to about 30 Salt River Pima-Maricopa Indian Community members who are currently caring for their loved ones. Caregiving is a very hard job that takes a lot of time and patience, and it often causes wear and tear on the caregiver.
According to the Foundation for Senior Living Web site, “Nearly 80 percent of seniors and adults with disabilities receiving long-term care are attended by family members, who are frequently not prepared to assume the medical, psychological and financial burdens they lovingly accept.” Presented by the SRPMIC Family Caregiver Support Program, the training was held at the Community Building.
Making Transfers Safely
First on the agenda was how to make safe transfers with the use of a gait belt. A “transfer” refers to moving someone with limited mobility from one position or place to another, as from a bed to a wheelchair or from a wheelchair to a vehicle. A gait belt is a sturdy canvas belt wrapped around the patient’s waist that allows the caregiver to get a strong grip on the patient. The belt also makes lifting and moving the patient easier on the caregiver.
“It is always important to take care of your back,” said Kilby.
Both ladies showed everyone the proper way to fasten the belt around the patient’s waist and how to use your leg muscles and not your back when lifting; the belt also helps keep the patient stable when standing.
“Always keep your feet together and [fasten] the belt around a patient’s waist snugly. Always let them know that you are going to lift them and have to get in very close,” Kilby said.
To lift someone up from a wheelchair, lock the wheels and put on the patient’s gait belt. Then it’s helpful to have them try to move forward, almost to the edge of the seat. They called this “nose over the toes,” meaning the patient is not leaning back in the chair when you try to stand them up. The purpose for this is to put less strain on the back of the caregiver and to provide support for the patient, whether moving them from a bed to a wheelchair or off the toilet. They demonstrated how to secure the gait belt and other techniques and made sure everyone could perform them well.
Other tips involved how to move back a slouching person into a wheelchair seat for better support and how to get an individual into a vehicle. The first step for a vehicle transfer is to always roll down the windows so the patient can hold onto that part of the door instead of the outside, where they could hurt their fingers. When getting into the vehicle, have the individual back up into the seat as far as possible, then put their legs in and secure the seat belt.
Another helpful trick is having the individual sit onto a big trash bag or other piece of plastic so they can slide into the seat, rather than having their clothing fight against the fabric of the seats.
Avoiding Pressure Ulcers (Bedsores)
The next part of the presentation dealt with the prevention of pressure ulcers. The attendees saw many photos of the stages of bedsores, so they can learn to identify them early and take steps to prevent them. “Prevention is better than treatment,” said Kilby. “Always keep the skin dry and keep the person hydrated, and change the individual’s position every two hours.”
Contributing factors for pressure ulcers include friction, moisture, poor diet, dehydration, body weight, illness, limited mobility and awareness, irritants, injury and smoking.
Kilby recommended aloe vera gel (not lotion) as a good ointment for the skin. You can find it in the first-aid aisle; make sure aloe juice is the first ingredient and not water.
A sensitive topic for many is incontinence, when a person is unable to control their bladder. The presenters explained bladder capacity and how it changes over time, from 2 cups as a young adult to 1 cup for many elders. Also, as people age they make more urine at night rather than in the daytime. Older folks also have less time from when their body first signals that they have to urinate and the time when it becomes immediate.
Decreased mobility, altered awareness, multiple medications, infections and dehydration all can impact urination patterns.
Patients with Dementia
Caring for a loved one with dementia can be particularly difficult, they said, because the person may no longer recognize you and may exhibit mood swings.
The trainers recommended taking a gentle approach because of the decline in memory, thinking and reasoning. There will also be a change in personality, mood and behavior, and many patients will have difficulty with language, recognition and carrying out their normal activities.
Dementia is irreversible. Kilby showed images of a normal-size brain and the brain of a patient with Alzheimer’s disease. Everyone could see that the Alzheimer’s brain had much less function than the normal brain.
“When communicating with them, always keep calm,” she said. “Always talk and move slowly so they do not feel threatened in any way. Never argue or yell at the person. If they are being confrontational, talk to them about something in their past life, an interest or use music to change the mood. Use short and simple sentences.”
She also shared tips to take the person away from their present environment by diversion or redirection, such as getting them to go take a bath or taking them to the doctor.
Becoming argumentative happens in dementia patients because they get confused and fatigued during the day, and it’s especially apparent later in the day. Always reassure them that they will be safe with you. Many caregivers asked why their loved ones with dementia tend to follow them all over the house, and the speaker indicated that it’s because the patients trust them and they don’t know where they are.
The workshop also covered bathing tips. After getting the person into the bathroom, make sure they can sit safely. Wash their feet first and go up from there. Always converse with them to keep them distracted. General home-safety tips also were included in the presentation.
For more caregiving tips or for other questions, contact the Community’s Family Caregiver Support Program at (480) 362-7983.